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Extremely Long, 190-cm Umbilical Cord Wrapped Six Times around the Neck
A 23-year-old woman (G2 P1; caesarean section 2 years before due to obstructed labor) with an ordinary course of pregnancy was admitted to the delivery room in her 39th week of gestation with irregular uterine contractions in an early stage of labor. The cervical canal was not effaced and was dilated 2 cm on admittance. The fetus was eutrophic, in cephalic dorsoanterior presentation with normal biophysical profile with reassuring cardiotocography (CTG). In a few hours, the woman developed regular contractions, and amniotomy was performed when the cervix was fully effaced and 4 cm dilated, and a continuous oxytocin infusion was started (5 IU of Syntocinon in 500 mL of a 5% glucose solution, infusion rate 20 mL/hour). Subsequently, epidural analgesia was applied. Labor then progressed to complete cervical dilation with head station 0, when sudden fetal bradycardia (60/min) without normalization was observed on the CTG over three minutes. Because of imminent fetal hypoxia, vacuum extraction was performed with an episiotomy, and a male neonate with multiple nuchal cords (wrapped 6 times around the neck) was delivered (3480 g/51 cm, Apgar score 10/10). Fetal pehametry was not done due to technical reasons. The placenta and membranes were delivered intact. The umbilical cord was quite long, measuring 190 cm in total ([Fig. 1]).
Umbilical cord lengths of 24–124 cm (mean 63.86 cm), 113, 150, and 160 cm have been reported in the literature     with consequent poor perinatal outcome including fetoneonatal asphyxia and fetal demise. An abnormally long umbilical cord is associated with an increased incidence of operative assisted delivery, intrapartum complications, and fetal heart rate abnormalities; greater chances of chronic fetal hypoxia and peripartal asphyxia; intrauterine growth restriction; fetal thrombotic vasculopathy; and stillbirth due to umbilical cord wrapping (nuchal cord with strangulation) and compression of the umbilical cord    . Due to chronic obstruction of the circulation and hence chronic fetal hypoxia, a longer umbilical cord with overcoiling is associated with intrauterine fetal growth restriction   . The 190-cm-long umbilical cord in this report is the first review in the literature.
19 April 2021 (online)
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- 1 Balkawade NU, Shinde MA. Study of length of umbilical cord and fetal outcome: a study of 1,000 deliveries. J Obstet Gynecol India 2012; 62: 520-525
- 2 Itakura A, Kurauchi O, Mizutani S. et al. Intrauterine growth retardation and fetal distress associated with the excessively long (160 cm) umbilical cord. Arch Gynecol Obstet 1994; 255: 99-100
- 3 Taweevisit M, Thorner PS. Massive fetal thrombotic vasculopathy associated with excessively long umbilical cord and fetal demise: case report and literature review. Pediatr Dev Pathol 2010; 13: 112-115
- 4 Prka M, Habek D, Živković K. Obstructed labour – Nuchal cords “extreme”. Z Geburtshilfe Neonatol 2016; 220: 39-40
- 5 Iwagaki S, Takahashi Y, Chiaki R. et al. Hypercoiled cord can cause a reversible abnormal Doppler in ductus venosus in cases of fetal growth restriction. J Obstet Gynaecol Res 2018; 44: 1922-1928